Lifespan and Healthspan: Past, Present, and Promise

Abstract

The past century was a period of increasing life expectancy throughout the age range. This resulted in more people living to old age and to spending more years at the older ages. It is likely that increases in life expectancy at older ages will continue, but life expectancy at birth is unlikely to reach levels above 95 unless there is a fundamental change in our ability to delay the aging process. We have yet to experience much compression of morbidity as the age of onset of most health problems has not increased markedly. In recent decades, there have been some reductions in the prevalence of physical disability and dementia. At the same time, the prevalence of disease has increased markedly, in large part due to treatment which extends life for those with disease. Compressing morbidity or increasing the relative healthspan will require "delaying aging" or delaying the physiological change that results in disease and disability. While moving to life expectancies above age 95 and compressing morbidity substantially may require significant scientific breakthroughs; significant improvement in health and increases in life expectancy in the United States could be achieved with behavioral, life style, and policy changes that reduce socioeconomic disparities and allow us to reach the levels of health and life expectancy achieved in peer societies.

Keywords: Compression of morbidity; Delaying aging; Health expectancy; Life expectancy; Trends in morbidity.

Figure 1.

Number of male life table deaths by age. Source of data: Bell & Miller (2005).

Figure 2.

Years of increase in life expectancy at ages 75, 85, and 95 years between 1900 and 2010 in the United States. Source: Bell & Miller (2005)

Figure 3.

Projections of U.S. life expectancy for 2050. Source: Social Security Projection, Bell & Miller (2005); Bongaarts (2006); Oeppen & Vaupel (2002): U.S. life expectancy 2010, Bell & Miller (2005).

Figure 4.

Dimensions of the morbidity process. Source: Crimmins et al. (2010)

Figure 5.

Trend in less severe disability among Americans aged 65 and older: Percent with any activity limitation (1963–2010) for (A) Males and (B) Females. Source: Minnesota Population Center and State Health Access Data Assistance Center, Integrated Health Interview Series: Version 5.0. Minneapolis: University of Minnesota, 2012. http://www.ihis.us. Trends adjusted for changes in question wording.

Figure 6.

Percent with dementia by age (2000–2010), Health and Retirement Study, age 75 years and older. Source: Calculations from Health and Retirement Study data. Dementia based on method in Crimmins et al. (2011).

Figure 7.

Trends in mean systolic blood pressure and mean total cholesterol (1960–2010). (A) Mean systolic blood pressure. Source: Kumanyika et al. (1998). 1960–1980. Calculated from National Health and Nutrition Examination Survey (NHANES) data: 1988–1994, 1999–2002, and 2007–2010. (B) Mean total cholesterol. Source: Carroll et al. (2005). 1960–2002. Calculated from NHANES data: 2007–2010. National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA. mdc3@cdc.gov.

Figure 8.

High blood pressure and high cholesterol (measured + medication), measured high blood pressure and high cholesterol, antihypertensive and cholesterol lowering medication use for older adults aged 65 and older. (A) Blood pressure, (B) total cholesterol. Source: NHANES.

Figure 9.

Average summary score of biological risk by age at three dates: Number of factors at high-risk level out of 9. Source: NHANES Data. Nine risk factors: total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides, obesity, HbA1C, C-reactive protein, systolic blood pressure, and diastolic blood pressure.